Non - DOTS regimens under RNTCP: reasons for initiation and treatment outcome.

Nearly 1% of the patients registered under RNTCP are put on non-DOTS regimens. Understanding the reasons for initiation of non- DOTS and its treatment outcome is one of the priority areas on the research agenda of RNTCP. In phase I the data of patients put on non DOTS at two TUs under Yavatmal DTC from April 2005 to March 2007 was collected from TB registers and treatment cards. In Phase II the reasons for initiating non DOTS was assessed in a sub sample by conducting two Focus group discussions with the staff at one of the TUs. In Phase III a comparison of the treatment outcome was done between patients on DOTS and Non DOTS by matched pair analysis using McNemar's chi square test. A total of 40 (1.28%) patients were put on non-DOTS. Nearly 27% of the patients on non DOTS belonged to the paediatric age group. Only one new smear positive patient and 11% of patients on retreatment after default were initiated on non-DOTS. The reasons for initiation of non DOTS was discussed for 27 patients registered at one TU in the FGDs. The main reasons for initiation of non-DOTS in new patients were drug intolerance, drug toxicity, liver disease, immunocompromised patient on ART and migration. The reasons in retreatment cases were persistent default and chronic smear positivity. The risk of un favourable outcome was significantly more in patients on non- DOTS. Many of the reasons for initiation of non-DOTS in new cases i.e. drug toxicity, intolerance; liver disease will continue to be indications for non DOTS in RNTCP areas. In some special circumstances interventions like DOTS plus and availability of ART compatible with Rifampicin will be better options for management of Tuberculosis. Default is a problem at all levels of treatment and concerted and coordinated efforts from various levels are needed to prevent it. Community DOTS providers can be involved in the programme in case of migration, some cases of persistent default and paediatric cases. The availability of Paediatric patient wise boxes will make it easier for dispensing DOTs in Paediatric Tuberculosis.